Dyadic Intervention Research Articles

From Organizing Medicine to Cooking With More Leafy Greens: A Dyadic, Qualitative Analysis of How Older African American Couples Take Care of Each Other's Health.

Guided by the Dyadic Theory of Illness Management, we explored spousal health management behaviors and their congruence within seventeen older African American married couples participating in a dyadic exercise intervention. Both prior to and after the intervention, spouses reported how they took care of their partner's health as well as what their partner did for them. Data were analyzed using theoretical thematic analysis, and five health management behaviors domains were identified (diet, exercise, self-care, medical compliance, relationship maintenance). Both partners were most likely to encourage healthier diets and exercise. Wives tended to report more behaviors compared to husbands. Couples had little congruence in their appraisals of each other's health management behaviors, and patterns were stable over time. Findings suggest incongruence in couples' health management behaviors represented complementary, collaborative efforts to support each other and that husbands may underestimate how much care they both provide to and receive from their wives.

When crying turns to hitting: Examining maternal responses to negative affect

Physical aggression in toddlerhood is empirically linked to anger and often conceptualized as a byproduct of frustration and related negative affect. Further, parenting is the major environmental construct implicated in the development of aggressive behaviors. Given parents’ role as “external regulators,” parents’ responses to their toddlers’ negative affect may serve to escalate or de-escalate their toddlers’ affective experience, thereby impacting the likelihood of subsequent aggression. In the present study, we examined whether parents’ negative affect, harsh, soothing, and distracting responses to their toddlers’ negative affect mediated the relation between toddlers’ negative affect and their aggressive behavior in brief conflict episodes. During a laboratory visit, a community sample of 69 mother-toddler dyads was observed in a structured interaction task. We found that child negative affect is associated with subsequent aggressive behavior by way of maternal harsh responses to negative affect. Negative emotional expression, soothing, and distraction neither facilitated or hindered children’s escalation from negative affect to aggression. Our findings support a dyadic intervention in which patterns of coercive parent-child interactions are targets for prevention and intervention of toddler aggression.

Epistemic Justice and Neurodiversity: Mentalization–Based Treatment with Children in the Autistic Spectrum from a Dimensional Perspective

ABSTRACT Neurodiverse individuals often suffer the consequences of epistemic injustice, that lead to isolation and helplessness. By attempting to apply a mentalization lens to ASD, we seek to highlight the concept of neurodiversity as an invitation to “mentalize differences” that arise primarily as a response to the marginalization of people with autism spectrum disorders. We seek to move away from the non-mentalizing impact of the categoric deficit model, providing an integration of both existing theoretical and empirical clinical data into an intervention to address the heterogeneity of neurodiversity. An adaptation of mentalization-based treatment for children (MBT-C) to the needs of children and adolescents functioning in the Autistic Spectrum is discussed. A clinical model that integrates findings of developmental research, dyadic clinical psychodynamic intervention models and neuroscientific data with the aim to develop an integrative therapeutic intervention both relational and developmental in nature. A mentalization informed dimensional approach is applied to the scaffolding process necessary to accommodate the heterogeneity and overall unique needs of this population. The article explores the need for further empirical research which substantiates the need for both systemic and individual interventions which address the subjective experience of ASD children and adolescents and that of their families.

The Impact of Dyadic Coping Intervention on Mental Health Problem and Quality of Life in Female Cancer Patients

Background: The mental health and quality of life in female cancer patients are of paramount importance, as a cancer diagnosis can significantly impact every aspect of a woman’s well-being. The need for interventions like dyadic coping, is crucial to address the complex emotional and psychosocial challenges these women face. Objective: The study investigated the effects of a dyadic coping intervention on the mental health and quality of life of female cancer patients. Methods: A quasi-experimental study was conducted with female cancer patients from a hospital in Riau Province, Indonesia, selected via purposive sampling. The intervention group consisted of 17 patients who underwent five dyadic coping training sessions based on the systemic transactional model, supplemented by follow-up phone calls from the researchers. An equal number of participants were assigned to the control group. The study analysed the data using descriptive statistics and independent t-tests, applying the DASS-21 scale for depression, anxiety, and stress, and the FACT-G scale for quality of life, both of which are validated measures. Results: The findings revealed that the dyadic coping intervention significantly reduced stress (p = 0.013), depression (p = 0.047), and anxiety (p < 0.001), and markedly improved quality of life (p = 0.017). Conclusion: These results suggest that dyadic coping interventions can effectively alleviate mental health issues and enhance the quality of life among female cancer patients, offering a viable alternative to traditional nursing interventions.

A novel framework for ketamine-assisted couple therapy.

Intimate relationship distress is prevalent and is associated with poorer health, mental health, and mortality outcomes. Evidence-based couple therapies target cognitive, behavioral, and emotional processes that underlie relationship dysfunction. Increasing research and clinical evidence supports the efficacy of ketamine-assisted psychotherapy (KAP) for addressing clinical mental health concerns, including depression, anxiety disorders, posttraumatic stress disorder, and more. The purported mechanisms of KAP are also likely to improve psychosocial and relational functioning for patients and may be useful for supporting change mechanisms in couple therapy. This paper reviews the current evidence for therapeutic ketamine and KAP and outlines how the mechanisms of ketamine therapy may also augment the cognitive, behavioral, and emotional interventions in the most commonly used evidence-based couple therapies. Key mechanisms include increased neuroplasticity, changes in functional connectivity, adaptive dissociation, decreased inhibition, and reduced avoidance. Given the reciprocal interaction between relationship dysfunction and mental health problems, ketamine may also help alleviate relationship distress by directly treating clinical mental health symptoms. We then outline a proposed framework for ketamine-assisted couple therapy, addressing the application of KAP preparation, dosing, and integration to a dyadic intervention framework in a way that can be applied to different couple therapy modalities. This clinical framework for couples' KAP may be useful for clinicians and researchers working to improve the efficacy of couple therapy, particularly when one or both partners has accompanying mental health concerns.

Evaluating the Dyadic Benefits of Early-Phase Behavioral Interventions: An Exemplar Using Data From Couples Living With Parkinson's Disease.

There are a growing number of early-phase (i.e., Stage I, NIH Stage Model) interventions targeted at family care dyads navigating chronic health conditions in older adults. Currently, the benefits of these interventions are often evaluated for older adults and their family care partners separately, even when controlling for interdependence. Without understanding the benefits (and potential harms) for dyads as a whole, understanding of program impact is incomplete. Moreover, few health behavior interventions involving dyads include relational measures to ensure no unintended consequences for the dyad or account for within-dyad pretest risk level. We used secondary data from a quasi-experimental trial involving 39 couples in which 1 member of the dyad was living with Parkinson's disease as an exemplar demonstration of 3 proposed approaches: an above-zero approach, a pretest risk status approach, and an expanded pattern analysis matrix approach. Approaches provided evidence for dyadic benefits of the intervention compared to the wait-list comparison condition, but carried different assumptions that did not always categorize dyads similarly. Implications of using each approach and selecting different benchmarks for defining success are discussed. The descriptive approaches proposed, provide a rationale for more intentional evaluation of small-sample, early-phase dyadic interventions.

Physical activity together for MS (PAT-MS): Secondary outcomes of a randomized controlled feasibility trial

BackgroundCare partners provide essential care to those with multiple sclerosis (MS). Dyadic interventions promoting health behaviours have wide-reaching benefits for individuals with MS and their care partners. However, behavioural interventions to promote physical activity in patient-caregiver dyads have yet to be explored in an MS-specific context. This study examined the secondary outcomes of the “Physical Activity Together for Multiple Sclerosis (PAT-MS)” intervention, including dyadic adjustment, caregiving tasks, caregiver quality of life, coping, and MS impact in MS dyads. MethodsA randomized controlled feasibility trial of the 12-week behavioural PAT-MS intervention. The Dyadic Adjustment Scale, Caregiving Tasks in MS Scale, Caregiver Quality of Life in MS Scale, Coping with MS Caregiving Inventory, and MS Impact Scale measured secondary outcomes of interest. Mixed-model ANOVAs were used to test changes in variables between groups (PAT-MS vs wait-list control) over time. Results20 participants, including 10 people with MS (51.4 ± 10.1 years old; median patient-determined disease steps (PDDS) score= 4, IQR= 1.25) and 10 care partners (48.5 ± 12.1 years old) were recruited and randomized. There was no statistically significant effect of the intervention on any of the secondary outcomes (p= 0.67–1.00). However, large effect sizes and condition-by-time interaction effects indicated improvement in dyadic adjustment (d= 1.03, ηp2= 0.45), the criticism-coercion coping subscale (d= -0.93, ηp2= 0.49), and caregiving tasks (d= 1.05, ηp2= 0.52), specifically within psycho-emotional (d= 1.47, ηp2= 0.38) and socio-practical (d= 1.10, ηp2 =0.37) sub-domains of caregiving tasks after the PAT-MS intervention compared to the wait-list condition. ConclusionWhile this pilot feasibility study was not powered based on the secondary outcomes herein, our findings indicate improvement in dyadic adjustment and emotional and social caregiving tasks, with reduced reliance on criticism-coercion coping in the PAT-MS group compared to controls following the intervention. Findings indicate that PAT-MS may improve dyadic psychosocial well-being of people with moderate-to-severe MS and their care partners, and this should be examined next in a fully-powered study.

DESIGN, DELIVERY, AND EVALUATION OF DYADIC INTERVENTIONS WITH OLDER ADULTS

Abstract With increasing evidence of the interpersonal context of health and illness, there is growing interest in interventions that target the needs of the family care dyad. Yet, there are often specific challenges to the design, delivery and evaluation of dyadic interventions that are not often disseminated. This session includes four papers that will discuss the benefits (but also challenges and lessons learned) of four different dyadic interventions targeted at older adults and their care partners in both cognitive impairment and chronic illness contexts. First, Dr. Rashelle Hoffman and colleagues will present results from focus groups with rural MCI care dyads that inform the adaptation of an existing efficacious telerehabilitation physical activity intervention (TPAB). Second, Dr. Glenna Brewster and colleagues will discuss recruitment and delivery challenges, and the benefits of a pilot behavioral sleep intervention for adults with cognitive impairment and their care partners. Third, Dr. Lyndsey Miller and colleagues will report the feasibility, acceptability and preliminary efficacy of a program to support preparation for future care needs and improved well-being in care dyads living with dementia. Finally, Dr. Karen Lyons and colleagues will present findings from a pilot communication-based intervention for couples living with heart failure. The presentation will discuss the individual versus dyadic benefits of the program and challenges related to recruitment and retention. Speakers and Discussant, Dr. Kalisha Bonds Johnson, will share challenges and best-practices in designing, delivering, and evaluating interventions to optimize the health and well-being of the older adult care dyad.

EXPLORING THE IMPACT OF CHORAL SINGING ON CHANGE IN PERCEIVED DISTRESS FOR CARE PARTNERS OF PERSONS WITH DEMENTIA

Abstract Family care partners (CP) of persons with dementia (PwD) report high levels of psychological distress that impact many facets of their lives. Arts-based interventions have shown promise for improving psychological health. Here, we describe findings from the Voices in Motion (ViM) study, a weekly lifestyle intervention for CP-PwD dyads, with specific emphasis on examining the impact of choral singing on level and change in perceived distress for CP. Data from n=29 CP (Mage=67.7 years, 80% female) were used to examine change in caregiver distress, indexed using the Zarit Caregiver Burden Interview (ZBI). ViM employed an intensive longitudinal design characterized by monthly retests embedded within 3.5-month choral seasons (up to 7 assessments per person). Choral seasons were separated by a 4-month summer break, yielding a naturalistic ABA experimental design optimal for evaluating the impact of choral singing on caregiver distress. Multilevel models of change with piecewise splines were fit; REML was employed due to its advantageous properties for small samples. A significant reduction in caregiver distress (-1.14 units per month, p<.01) was observed across the 3.3-month span of season 1. Following the 4-month summer break, level of caregiver distress at the outset of season 2 had increased back to initial baseline levels (ZBI =19.9 units – a moderate to borderline-high level), thereby underscoring the importance of the choir intervention. These findings suggest that lifestyle engagement may offer an effective complement for lessening the impact of caregiver distress for CP, with implications for the development of dementia care plans.

BUILDING RESILIENCE IN SKILLED NURSING (BRISK): A CASE OF COMMUNITY-ENGAGED RESEARCH IN SKILLED NURSING FACILITIES

Abstract Older adults receiving post-acute rehabilitation care in a skilled nursing facility (SNF) commonly present with high physical, psychological, and social needs. Psychosocial stressors and associated consequences (e.g., poor transitions, re-hospitalizations) may be magnified among families with limited financial resources. The current study aimed to co-develop a dyadic psychological intervention tailored to meet the unique psychosocial needs of socioeconomically disadvantaged patients and their care-partners during the transition from SNF to home. In this presentation, we describe the process of partnering with SNFs and forming a community advisory board (CAB) to meet the objectives of the current study. First, we discuss practical and regulatory considerations related to identifying facility partners (e.g., facility chains, physician groups) and recruiting patient-care-partner dyads in partner facilities. Second, we highlight strategies to incentivize potential SNF partners as well as historically and systematically under-represented patient participants, including budgetary considerations, recruitment strategies, sustained contact after discharge, and clinical service provision. Third, we discuss the recruitment, formation, and role of a CAB with diverse perspectives, including patients, family care-partners, SNF staff, policy makers and advocates. Overall, this presentation will generate discussion on practical strategies for building and maintaining mutually beneficial research partnerships with SNFs and similar hard-to-reach healthcare settings (e.g., long-term care facilities, home health agencies).

THE READYR PROGRAM FOR WELL-BEING IN DEMENTIA: PILOT STUDY AND SIX-MONTH FOLLOW-UP RESULTS AMONG SPOUSE–PARTNER DYADS

Abstract The READyR Program assesses and targets everyday routines of care dyads (older adults with cognitive impairment and their co-habiting partners) using in-home sensors and video-conference sessions in order to understand future care needs, and promote greater well-being. This study aimed to evaluate the feasibility, acceptability, and pilot test of efficacy for READyR. Fifteen dyads (96% married) were enrolled in the 6-month study, and randomized to immediately join READyR (n=8 dyads) or to complete READyR after an educational control condition (n=7 dyads). Feasibility was high: 100% of enrolled dyads completed ≥1 session; 80% completed all sessions. Acceptability was also high: responding participants (n=26) reported that READyR helped them express their care values and understand their care needs (92%), that they were comfortable sharing their views (92%) and doing so with their partner present (96%). Hearing and visual impairments were reported to interfere with online sessions for 4 and 6 participants, respectively, but 93% of participants reported that the digital components were easy to use and understand. After receiving the READyR sessions, awareness of future care needs among care partners increased (d = 0.85) and relationship strain for both dyad members decreased (d = 0.58–0.82), when compared to changes among participants in the active control group. No effect was observed on participants’ quality of life, mood, or care-related strain at post-test or at 6 month follow-up. As a remote dyadic intervention, READyR is feasible, acceptable, and may help dyads decrease strain in the care relationship and prepare for future care needs.

RELATIONSHIP-TYPE DIFFERENCES IN SUPPORT SEEKING AND MENTAL HEALTH FOR ADULT CHILDREN OF PARENTS WITH MEMORY LOSS

Abstract Research shows that midlife children still rely on their parents for emotional and tangible support, which has implications for their mental health. Little is known about how these dynamics change when a parent enters the early stage of dementia or memory loss. One characteristic that may be important for these dynamics is the relationship-type (daughter-mother (n= 82), daughter-father (n= 29), son-mother (n=17), son-father (n= 14)). As part of a larger study, adult children 18 years of age and older (n= 142) completed self-report surveys including measures of emotional and tangible support seeking from their parent (Feeney, 2004), the 10-item CESD (Orme et al., 1986), the 12-item Zarit Burden Inventory (Bédard et al., 2001), and the PANAS (Watson et al., 1988). Results showed that tangible and emotional support seeking levels were low across all dyad-types, with no differences between groups. There was a trend for depressive symptoms (F= 2.559, p= .058) showing more in daughter-father than in son-mother dyads. Daughter-father dyads were the only group meeting the depression cut-off score. There were significant differences for burden (F= 3.377, *p= .020) with more burden in daughter-mother compared to son-father dyads. For the PANAS (F= 2.926, *p= .036), there was more negative affect in daughter-father compared to daughter-mother dyads. Results suggest that the relationship-type of the adult child and parent matters for mental health in the early stages of memory loss. This has implications for dyadic interventions helping adult children and their parents cope in the early stages of the dementia caregiving journey.

SUPPORT EXCHANGES IN COUPLES COPING WITH EARLY-STAGE ALZHEIMER’S DISEASE

Abstract People living with Alzheimer’s disease (AD) typically receive considerable support from their spousal caregivers. Yet, we know little about whether people with early-stage AD may still be able to help their caregivers and how potential support exchanges in these couples may vary depending on the quality of their relationships. We drew on dyadic data from 37 older couples in which one partner lives with mild-to-moderate AD (Mage = 77yrs, 48% male) and the other serves as a spousal caregiver (Mage = 76yrs, 53% female). Couples participated in concurrent interviews during which they each reported on a variety of demographic and relationship characteristics, such as relationship quality, and couple support exchanges. People with early-stage AD perceived their relationships with spousal caregivers as more positive and less negative than did these caregivers. Support did not flow unidirectionally in these caregiving couples, especially not among those in better-quality relationships. Specifically, caregivers who viewed their relationships as more positive/less negative considered it less stressful to provide emotional and practical support to their partners with AD. Patients who viewed their relationships as more positive/less negative provide more frequent emotional and practical support to their caregivers and also found such support provision more pleasant and less stressful. Findings reveal positive contribution that older adults with dementia, who have been solely treated as recipients of care, can make and shed light on the development of dyadic interventions by highlighting the importance of mutually beneficial relationships in early stages of AD.

A Dyadic Behavioral Sleep Intervention Program for Persons Living With Dementia and Their Family Caregivers: A Pilot Randomized Controlled Trial

AbstractBackgroundUntreated sleep problems in persons living with dementia (PLWD) and their caregivers impact health outcomes of both individuals and impair quality of care for caregivers. This study pilot tested preliminary effects of a dyadic sleep intervention program among this group.MethodThirty PLWD/caregiver dyads were randomized to a 5‐session treatment (n = 15 dyads) or a similarly structured information‐only control group (n = 15 dyads) via in‐person or video‐telehealth. Treatment was a manual‐based program incorporating key components of cognitive behavioral therapy for insomnia (CBTI), daily light exposure and walking, and a problem‐solving approach for dementia‐related behaviors and caregiving challenges. Sleep outcomes included actigraphy‐measured sleep efficiency (SE) and total awake time (TWT) at night for dyads, and Pittsburgh Sleep Quality Index (PSQI) for caregivers. Outcomes were measured at baseline, post‐treatment, and 3‐months follow‐up (main outcome time point). Recommendation adherence in the treatment group was computed and a 2 (group) by 3 (time) mixed model analysis of variance was used to test the treatment effects (p<0.20 as the threshold).ResultTwo dyads in treatment and one control dyad did not complete all five sessions. Of 13 dyads who completed all sessions of the treatment program, average % days that the dyads met their sleep schedules were 76% bedtime and 83% get‐up time for PLWD and 81% bedtime and 68% get‐up time for caregivers. From baseline to 3‐month follow‐up, SE increased by 3.2% more for PLWD in the treatment group (n = 9) compared to control (n = 9, p = 0.48) and by 3.7% more for caregivers in the treatment group (n = 12) compared to control (n = 9, p = 0.17). TWT also reduced by 19 minutes more for PLWD and 14 minutes more for caregivers in the treatment group compared to control at the 3‐month follow‐up although this was not statistically significant. Caregivers in treatment also showed non‐significant improvement on the PSQI (p>0.20).ConclusionA dyadic approach to sleep improvement showed evidence of benefit among PLWD and caregivers. A larger study is needed to fully evaluate these effects and compare in‐person to telehealth modalities.

Factors Associated With Dementia‐Related Behaviors Among Caregivers Experiencing Poor Sleep

AbstractBackgroundNeuropsychiatric symptoms of dementia are common and have the potential to negatively impact the physical and mental health of family caregivers, hindering their ability to provide care. Such impact may be worse among caregivers experiencing poor sleep. This study aimed to explore factors associated with the frequency of and caregivers’ distress to dementia‐related problematic behaviors.MethodThis was a cross‐sectional study, using data from a clinical trial of dyadic sleep intervention for persons living with dementia (PLWD) and their family caregivers. Dementia‐related behaviors were measured using a 24‐item, Revised Memory and Behavioral Problems Checklist (RMBPC): total scores of frequencies and caregivers’ distress; scores for three subscales (memory‐related, depression, and disruptive behaviors). Caregiver‐related variables included demographic background, Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), Pittsburgh Sleep Quality Index (PSQI), and Center for Epidemiological Studies of Depression (CESD). Patient‐related variables included activities of daily living (ADLs), instrumental ADLs (IADLs), and Mini‐Mental State Examination (MMSE) scores. A total of 47 dyads were included in the analysis (caregivers: n = 29 spouses, n = 17 non‐spouses; 40% Whites). Pearson correlation analyses were conducted.ResultHigher ZBI and CESD scores were significantly associated with higher RMBPC frequency total (r = 0.41, r = 0.48, respectively; p<0.01) and caregiver distress total scores (r = 0.58, r = 0.43, respectively; p<0.01). Lower PAC (r = ‐0.31, p = 0.04) and higher MMSE scores (r = 0.37, p = 0.03) were also associated with higher caregiver distress total scores. ZBI and CESD scores were associated with RMBPC‐depression subscale scores (frequency/caregiver distress). There were positive associations between CESD and MMSE with RMBPC‐disruptive behaviors (frequency), and ZBI and PAC scores with RMBPC‐disruptive behaviors (caregiver distress). No patient or caregiver‐related factors were associated with RMBPC‐memory subscale scores. There was no significant association between PSQI scores and RMBPC total/subscale scores. Patient factors were not significantly associated with RMBPC frequency total or caregiver distress total scores.ConclusionDementia‐related problems, particularly depressive symptoms and disruptive behaviors of PLWD are associated with both positive and negative aspects of caregiving. Future studies will need to further examine how each RMBPC subscale of behavior contributes to caregiver burden or perceived caregiving experiences among family caregivers.

Results of a post‐diagnostic intervention for people with dementia and their family carers

AbstractBackgroundSupport directly after the diagnosis dementia is often experienced as inadequate by people with dementia and their family carers. Often, available support is focused on practical matters and not on the emotional impact of the diagnosis. The innovative intervention SHARE [Support, Health, Activities, Resources, Education] was developed in the USA for dyads (i.e. person with dementia and their family carer) dealing with early‐stage dementia. Its primary goal is to enhance communication between members of the dyad and to prepare them for the future. The intervention has been adjusted and pilot‐tested in the Netherlands, with positive results. The aim of this study was to investigate the impact of the intervention on dyads on a number of primary and secondary outcome measures.MethodA pre‐post study with three measurements (T0; pre‐ intervention, T1; post‐ intervention, and T2; six months post‐intervention) was conducted. Additionally, a process evaluation took place and qualitative data were collected. Primary outcomes were the quality of life of the person with dementia and self‐efficacy of the family carer. Secondary outcomes were stress, quality of the relationship, confidence in the future, usability and applicability of the intervention and (for family carers only) empathy. Data was collected through structured questionnaire research among 50 dyads, structured interviews with 18 dyads, 19 psychologists and 31 referring professionals, analysis of 55 intervention logs and a group discussion with case managers.ResultNo significant effects were found on the primary and secondary outcomes. However, qualitative results demonstrated the added value of the intervention for dyads, psychologists and referring professionals. Usability, acceptability and applicability of the intervention were all positively assessed.ConclusionAs no significant effects were found, we theorize that the intervention protects dyads. Usually, with a progressive disease like dementia, scores on the primary and secondary outcome measures decline, as time and hence the disease progresses. Our findings may indicate a protective effect of the intervention, among others on a further decline in quality of life of the person with dementia, and it may help maintain a stable level of self‐efficacy for the family carer.

Physical activity together for couples living with mild cognitive impairment (PAT-MCI): A feasibility study

Mild cognitive impairment is a prodromal phase of Alzheimer's disease and related dementias. Cognitive and/or neuropsychiatric symptoms that could worsen over time cause challenges for patients and romantic partners, who often assume the role of informal caregivers. Although physical activity is beneficial, older adults with mild cognitive impairment and their romantic care partners are generally physically inactive. Our 16-week study was performed to see whether physical activity together is feasible to increase physical activity among four dyads (individuals with mild cognitive impairment and their spouses). Our dyadic intervention was feasible given more than 70 % of participants self-reported adherence to physical activity based on the guidelines for adults in the United States. In exit interviews, togetherness was highlighted as one of the biggest strengths of this study. Future studies with more representative samples are needed, as well as adopting a more tailored approach that accounts for individuals’ levels of physical fitness.

Habit Efficacy Trial: A Multi-Site Randomized Controlled Trial of Community Health Worker Support to Increase Hydroxyurea Adherence of Youth with Sickle Cell Disease

Introduction: Despite disease-modifying effects of hydroxyurea (HU) on sickle cell disease (SCD), poor adherence among affected youth commonly impedes treatment impact. The HABIT multi-site randomized controlled efficacy trial aimed to increase HU adherence. Methods: Youth with SCD ages 10-18 years with impaired adherence were identified through laboratory evidence, primarily flagging levels of treatment-induced fetal hemoglobin (HbF). Eligible youth were enrolled as dyads with their primary caregivers for one year. We tested a 6-month phase of semi-structured supportive, multi-dimensional dyad intervention led by community health workers (CHW) with 4-5 visits addressing information, social issues/referrals, barriers, habit formation using goal-setting and cues, augmented by daily tailored automated text message reminders, compared to standard care. This phase was followed by a 6-month sustainability phase (months 7-12) of observation and, for the intervention group, 1 CHW booster visit. Primary intervention outcomes were 1) HbF levels compared to enrollment; and 2) proportion of days covered (PDC) for HU versus the pre-trial year. The secondary outcome was sustainability of these changes up to month 12. Results: Starting in 2020, the COVID-19 pandemic disrupted enrollment and clinic-based procedures. The trial enrolled 50 dyads, missing target enrollment. Compared to enrollment levels, both HbF level and PDC significantly improved within the intervention group at month 6 (p=. 03 and . 01, respectfully), with parallel increased MCV (p=.05). Increased HbF did not reach signifance compared to controls (p=.07). No significant within- or between-group differences were found at month 12. Conclusions: Within-group results suggest that our CHW-based dyad intervention with text message reminders improved HU adherence at 6 months but there were no between-group differences. Effects did not endure through the subsequent 6-month sustainability phase. These findings suggest that improved HU adherence for youth with SCD though our community-based, multi-modal support for youth-caregiver dyads temporarily improved usage. Durability of impact on adherence may require integrating CHW-led support and text reminders into clinical care.

Effectiveness of Dyadic Psychoeducational Intervention on Cancer Patients and Their Caregivers: A Systematic Review and Meta-analysis.

Dyadic psychoeducational intervention targets the dyads of cancer patients and caregivers as active participants in partnership, which can potentially address the needs and challenges faced by patients with cancer and their caregivers. However, there is insufficient evidence on the effectiveness of the intervention on psychological health and illness-related outcomes among the dyads. To systematically examine the dyadic psychoeducational intervention of cancer patients and their caregivers on psychological health and illness-related outcomes. Cochrane Library, EMBASE, CINAHL, PsycINFO, PubMed, Web of Science, and 4 Chinese databases were searched from inception to May 29, 2022. Two investigators independently extracted data and evaluated methodological quality. RevMan 5.4 was used for meta-analysis; heterogeneity was evaluated using Higgins' I2 (%). Standardized mean difference (SMD) with a 95% confidence interval (CI) was used to assess the effects. Eight randomized controlled trials that involved 1234 dyads were collected. Meta-analysis showed that the intervention was effective in reducing the dyadic depression (patients' SMD, -0.41 [95% CI, -0.78 to -0.04; P = .03]; caregivers' SMD, -0.70 [95% CI, -1.31 to -0.09; P = .03]). It also improved caregivers' quality of life (SMD, -0.29 [95% CI, -0.56 to -0.03; P = .03]), whereas no significant effect was found on patients' quality of life. Dyadic results including anxiety, self-efficacy, disease communication, and appraisals of illness/caregiving were observed. Dyadic psychoeducational intervention reduced the dyadic depression. It also improved caregivers' quality of life. Nurses can apply dyadic psychoeducational intervention in clinical practice. More studies are needed to draw higher-quality conclusions and investigate the effects on psychological health and illness-related outcomes in cancer patients and caregivers.

Integrated model of maternal caregiving in child HIV management in Chinese mother–child dyads living with HIV: A qualitative dyadic analysis

AbstractPerinatally HIV‐positive (PHIV+) children face challenges arising from their complicated and highly stigmatized chronic illness throughout childhood and adolescence. Caring and support from caregivers are vital, especially from their mothers who also live with HIV. However, little is known regarding how HIV+ mothers coach their PHIV+ children to adjust to HIV. This study used dyadic‐level qualitative analyses of semi‐structured, one‐on‐one interviews among 20 mother–child dyads (n = 40; children aged 12–18 years) living with HIV in southern China. Interviews examined the perspectives of both mothers and children on the maternal caregiving in child HIV management and child adaptation outcomes. Our findings showed that based on a dual‐dimension model of the extent of maternal involvement in child HIV management and the intimacy of the mother–child relationship, four categories of maternal caring emerged among the mother–child dyads: supportiveness (n = 4, 20%), independence (n = 9, 45%), contradiction (n = 4, 20%) and alienation (n = 3, 15%). The PHIV+ children's selected HIV management indicators (including disclosure of HIV status, HIV‐related communication, antiretroviral therapy adherence, stigma coping and emotion management) also showed some variations among these four categories. The integrated model may inform the development of dyadic intervention programmes tailored for mothers and children both living with HIV.